Orbital Decompression

Orbital decompression involves removing some bone from {the} eye socket to open up one or more sinuses and so make space for {the} swollen tissue and allowing {the} eye to move back into normal position.


The CT above shows {the} orbit on {the} left following orbital decompression. Note how {the} muscle bows inward, into {the} area of {the} sinus - now that this orbital wall has been surgically removed.


  • Optic Neuropathy. Even though some patients undergo spontaneous remission of symptoms within a year, various need treatment. The initially step is {the} regulation of thyroid hormones levels by an endocrinologist.
  • Topical lubrication of {the} ocular surface is used to avoid corneal damage caused by exposure. Tarsorrhaphy is an alternative option when {the} complications of ocular exposure can't be avoided solely with {the} drops.
  • Corticosteroids are efficient in reducing orbital inflammation, but {the} benefits cease after discontinuation. Corticosteroids treatment is also limited because of their various side effects. Radiotherapy is an alternative option to reduce acute orbital inflammation. Unfortunately, there is still controversy surrounding its efficacy. A simple way of reducing inflammation is smoking cessation, as pro-inflammatory substances are found in cigarettes.
  • Surgery could be done to decompress {the} orbit, to improve {the} proptosis and to address {the} strabismus causing diplopia . Surgery is performed once {the} patient’s disease has been stable for at least six months. In severe cases, however, {the} surgery becomes urgent to prevent blindness from optic nerve compression.
  • Eyelid surgery is {the} most common surgery performed on Graves ophthalmopathy patients. Lid-lengthening surgeries can be done on upper and lower eyelid to correct {the} patient’s appearance and {the} ocular surface exposure symptoms. Marginal myotomy of levator palpebrae muscle can reduce {the} palpebral fissure height by 2-3 mm. When there is a more severe upper lid retraction or exposure keratitis, marginal myotomy of levator palpebrae associated with lateral tarsal canthoplasty is recommended. This procedure can lower {the} upper eyelid by as much as 8 mm. Other approaches include müllerectomy (resection of {the} Müller muscle), eyelid spacer grafts and recession of {the} lower eyelid retractors. Blepharoplasty can also be done to debulk {the} excess fat in {the} lower eyelid.
  • If {the} optic nerve is compromised, and vision is threatened as a result of Graves' disease, {the} term optic neuropathy could be applied.

Orbital Decompression Surgery

  • In orbital decompression surgery {the} bone between {the} orbit (eye socket) and {the} sinuses (air spaces next to {the} orbit) is removed.
  • A successful procedure improves vision and provides room for {the} eye to slip back into {the} orbit's protection.
  • There are possible complications of {the} surgery, however.
  • You could experience lip numbness for several months after {the} operation.
  • Double vision could persist or it could develop anew after surgery

Orbital Decompression
Orbital Anatomy

  • Orbital volume and dimensions: = 30 cc, 35(Height) x 45(Width) x 45 mm(medial wall depth), globe 25 x 25 mm
  • Bones: (F)rontal, (M)axillary,(Z)ygomatic, (L)acrimal, (E)thmoid, (P)alatine, (S)phenoid
  • makes room to put {the} eyes back in {the} socket and correct {the} proptosis (bulging).
  • {the} bone between {the} orbit and {the} Sinuses (Sinus is {the} air spaces next to {the} orbit) is removed.
  • goal is to improve vision and provides room for your eye to slip back into {the} orbit's protection.
  • complications
    • lid numbness
    • double vision
    • CSF leak (of cerebrospinal fluid that surrounds and protects {the} brain)


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